Perioperative medicine?

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I've seen some references within some of the anesthesia literature advocating that the field transform itself to perioperative medicine. Anyone have a sense as to how far that would go? I know there is some evidence that preop clinics run by anesthesia reduces canceled/delayed cases, so the pre op part makes sense. Would it go so far as the anesthesiologist (as a "perioperative physician") follow the pt during the post op floor admission, rounding and doing all that stuff, leaving the surgeons to be pretty much technicians?

 

[Bertelman]

Reducing cancelled cases/delays is a money saver for the hospital, not so much the anesthesiologist. I wouldn't expect the average PP gasman to start staffing an outpt. clinic. Hell, that's why we didn't go into IM. I think this system works great at academic institutions, where the pre-op surgery clinic is run with deadbeat MS3s like me. This tends to be accomplished in the real world with an IM consult from Surgery prior to the Op day. Billed to insurance.

As for the floor patients, the surgeons need to stay on top of those. They performed the procedure, they are (hopefully) intimately aware of the surgical complications inherent to the procedure and the presentation of said complications. They know when to pull lines, d/c, etc.

 

[cchoukal]

A lot of universities do have pre-op clinics with the purpose in mind of reducing case cancellations, reducing the number of cases that go because "well, they're here," and providing additional education. I don't know if this takes place in private practice. As far as post-op care, at our institution, our anesthesia pain service follows quite a number of patients, but just with regard to pain mgmt. I've been told by attendings that in europe and canada the role of anesthesiologists in post-op care is more central and primary; the so-called "surgeon as technician" model, but I don't have any direct experience of this. My understanding, having heard the incoming ASA president speak, is that there's a lot of disagreement w/in the ASA about whether we want to embark on that path.